Wednesday, January 19, 2011

We should stop putting blame on obese people

By Paul Zimmet (Professor Paul Zimmet AO is director emeritus of the Baker IDI Heart and Diabetes Institute, Australia, and an international authority in public health aspects of obesity and diabetes)

It is time to ask if we have the right strategies to fight the national and global obesity epidemics. Since the last Australian Diabetes and Lifestyle study in 2005, there has been no reliable national monitoring data and nothing to suggest we are winning the war. It could be 2013 or 2014 before new data are available.

While the government may be about to enact some of the easier recommendations of the 2009 Preventative Health Taskforce report, the strong message was that the recommendations needed to be implemented as a package. Otherwise, there is unlikely to be any real impact on obesity, which is by far the main driver of the Australian diabetes and heart disease epidemics.

The failure to respond aggressively is very disappointing. We need to challenge the myth that sloth and sedentary behaviour are largely responsible for obesity. We need to stop arguing that individuals and parents are solely responsible.

Politicians and health bureaucrats need to acknowledge the changed thinking of scientists and researchers about the underlying cause of obesity. A significant biological component drives the very behaviour we focus on.

A major part of obesity is hereditary. There are also lifelong consequences of poor or excessive maternal nutrition. Children who have poor nutrition before birth are predisposed to obesity, type 2 diabetes, heart disease and even mental disorders in adult life.

For indigenous Australians, this disadvantage predisposes them to chronic diseases in adulthood.

Maternal diabetes and obesity shape the way the foetus responds, making it more likely that a child will develop obesity and diabetes.

A mother's behaviour during pregnancy has profound effects on her baby's responses to the environment in adult life. Diabetes and obesity in the mother, malnutrition, smoking, alcohol and drug abuse all have an effect on the baby's genetic material.

So these changes create a vicious intergenerational pattern of susceptibility to chronic disease. But appropriate advice and education, intervention during pregnancy, and even before, can reverse this escalating obesity epidemic.

Two renowned Australian researchers, Boyd Swinburn and Garry Egger, have even described the world and our environment as "obesogenic".

Societal changes are so profound that parents can no longer control many of the behavioural, socio-cultural and economic changes that affect their children. Because of the rapid pace of change, many parents do not have the knowledge or skills.

We in the public health arena need to explain more effectively this new way of thinking and present the problem as a combination of individual and population vulnerabilities. Many factors are not the ''fault'' of the individual.

It is unfortunate that much of the media fuels the belief that obesity is primarily caused by sloth and gluttony. This invites a passive response and allows government to put the responsibility on individuals - particularly when it comes to intervening with children.

Intergenerational change and the lack of nutritional understanding mean that parents are ill equipped to deal with nutrition education and other lifestyle issues. Action needs to start before birth and rely on the new science of epigenetics.

Our governments and public health agencies need to work out how to engage meaningfully with the food industry and recruit it to the fight. We need to work out better ways to interact with these companies. Unlike smoking, we cannot live without eating, and we cannot win this battle without their co-operation.

An Access Economics report in 2008 put the cost of obesity in Australia and its impact from chronic disease and economically at $58 billion a year. The potential cost of implementing the recommendations of the Preventative Health Taskforce would seem an absolute bargain against this. It is time to stop the culture of blame. I hope our governments are listening.


Statins 'may cause loss of memory and depression'

And that's not half of it. Many people given statins decide that they would rather take the risk of a heart attack than continuing to take them

Cholesterol-lowering pills taken by millions of Britons may cause memory loss and depression, researchers warn. They say not enough is known about the level of harm posed by statins, prescribed to prevent heart disease and strokes. Leading doctors say that the drugs should only be taken by patients for whom the benefits of the drug outweigh any potential risks.

More than seven million people in Britain now take statins – as many as one in three adults over the age of 40. They are extremely effective in lowering levels of cholesterol, the fatty substance in the blood that clogs up arteries leading to heart attacks and strokes. Many people over the age of 45 are routinely prescribed statins by their GPs if they have slightly high blood pressure or cholesterol.

In addition low-dose pills are increasingly bought over the counter without a prescription. Although they have been proven to be extremely effective – saving up to 10,000 lives a year – researchers warn that not enough is known about their risks.

They warn statins should only be prescribed to those with heart disease, or who have suffered the condition in the past. Researchers warn that unless a patient is at high risk of suffering a heart attack or stroke, statins may cause more harm than good.

The study, published in the Cochrane Library, which reviews drug trials, also points out that the vast majority of trials have been carried out by drugs companies who may play-down any possible risks. Some patients taking statins have suffered from short-term memory loss, depression and mood swings.

Previous studies have also linked the medication to a greater risk of liver dysfunction, acute kidney failure, cataracts and muscle damage known as myopathy.

The researchers examined data from 14 drugs trials involving 34,000 patients. They found that although the drugs did prevent heart attacks and strokes, there was not enough evidence to prescribe them to patients with no previous history of heart disease.

Professor Shah Ebrahim, from the London School of Hygiene and Tropical Medicine said: ‘When you put the evidence together you certainly find it supports the use of statins. But we found that evidence of potential harm is not being taken seriously. ‘The adverse effects are not included in the trials.’

Lead researcher Dr Fiona Taylor, added: ‘The decision to prescribe statins in this group [who have no history of heart disease] should not be taken lightly.’

Amy Thompson, senior cardiac nurse at the British Heart Foundation, said: ‘This systematic review echoes what we already know – that statins have huge benefits for people with heart and circulatory disease, or those who are high risk – they help to reduce the risk of heart disease including heart attacks.

‘It is still unclear whether statins provide any real benefits for people without heart and circulatory disease and who are at low risk.’


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